15D0722964 CLIA NUMBER - KOSCIUSKO AMBULANCE SERVICE LLC

Laboratory Demographics

  • CLIA Code: 15D0722964
  • Facility Name: KOSCIUSKO AMBULANCE SERVICE LLC
  • Facility Address: 445 ANCHORAGE ROAD
    WARSAW, IN
    ZIP 46580
  • Facility Phone: 574 269-1975
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: ALICIA M. MEDIANO
  • NPI Number: 1780068122
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 15D0722964
LAB Type Ambulance
Facility Name KOSCIUSKO AMBULANCE SERVICE LLC
Street 445 ANCHORAGE ROAD
City WARSAW
State IN
ZIP 46580
Phone 574 269-1975
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Ambulance
Lab Director ALICIA M. MEDIANO

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This page was last updated on: 9/29/2025